We have long known that real-world black-white racial disparities have existed in the treatment and outcomes of patients with renal cell carcinoma (RCC). However, it is unclear how these disparities will change with the recent introduction and widespread adoption of oral anticancer agents (OAAs). As with any advance in medical technology, the introduction of these agents has the potential to significantly improve patient outcomes, but also has the potential to exacerbate current disparities if these advances in OAAs are not equally available or do not provide the same benefit to all patients. The proposed study addresses this critical gap in our knowledge by investigating a mix of nationally representative, yet diverse populations of patients with kidney cancer in the United States. Unfortunately, no single dataset of patients with kidney cancer exists that is able to capture nationally-representative data on patients of all ages and all insurance status within the United States. However, by using three complementary data sources we are able to include patients of all ages, insurance, geography, and race to investigate the current and future utilization, outcomes, and costs associated with emerging OAAs in patients with kidney cancer. Aim 1 ? Investigate patient-level disparities in OAA use in RCC patients Aim 2 ? Investigate provider- and system-level disparities in OAA use in RCC patients.. Aim 3 ? Investigate the impact of patient-provider networks (PPNs) on OAA adoption and identify pockets of late or non-adopting providers. The proposed research will (1) assess and describe the current state of oral anticancer medication utilization, delivery, and adherence; (2) identify patient, provider, structural, and systemic barriers to adherence and disparities in outcomes; and (3) develop models and strategies to improve safe and effective delivery of these agents in order to improve access to optimal clinical care and outcomes. .